Abstract: SA-PO252
Successful Multitarget Therapy in Refractory Lupus Nephritis: A Retrospective Cohort
Session Information
- Clinical Glomerular Disorders: Vasculitis, C3G, IgAN
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Glomerular
- 1005 Clinical Glomerular Disorders
Authors
- Oliveira, Camila Barbosa lyra, Hospital das Clínicas - UFPE, Recife, Brazil
- Costa, Denise Maria do nascimento, Hospital das Clínicas - UFPE, Recife, Brazil
- Vajgel, Gisele, Hospital das Clínicas - UFPE, Recife, Brazil
- Vasconcelos, Carolina Andrade jordão, IMIP, Recife, Pernambuco, Brazil
- Cavalcante, Maria Alina G.M., Hospital das Clínicas - UFPE, Recife, Brazil
- Valente, Lucila Maria, Hospital das Clínicas - UFPE, Recife, Brazil
Background
Multitarget therapy (MT) with mycophenolate mofetil (MMF), calcineurin inhibitor and steroids has been studied for induction treatment of lupus nephritis (LN). Nevertheless, its use in refractory LN is still being evaluated.
Methods
Retrospective cohort study of adult patients with refractory LN (EULAR/ERA-EDTA recommendations) treated with MT. Clinical characteristics, serological data and long-term follow-up were analyzed. Complete response (CR) and partial response (PR) were defined by KDIGO Clinical Practice Guideline for Glomerulonephritis.
Results
Data from 8 patients with refractory LN are shown in Table 1. The mean age was 34.6 ± 6 years and 87.5% were female. Mean sCr was 0.8 ± 0.2 mg/dl and median proteinuria was 3.7 (3.1 – 4.1) g/24h. All patients were treated with MMF (1 – 2g/day) plus cyclosporine A 2.5 – 4.0 mg/Kg/day (7 patients) or tacrolimus 0.06 mg/Kg/day (1 patient) plus steroids. After a follow-up of 18 (7.5 – 29.8) months, 7 patients had CR or PR, mean sCr was 1.0 ± 0.3mg/dl and median proteinuria was 1.4 (0.8 – 2.0) g/24h. There were no major adverse events (severe infections or drug nephrotoxicity).
Conclusion
MT successfully induced CR or PR in most patients with refractory LN with no major adverse events.
Table 1. Patients characteristics and long-term follow-up of Multitarget Therapy in refractory lupus nephritis
| No | Age (yrs) | Gender | ISN/RPS Classification | Before Multitarget Therapy | Multitarget Therapy | |||||||||
| Induction Treatment | sCr mg/dl | Prot g/24h | 6 months | 12 months | Last visit | |||||||||
| sCr mg/dl | Prot g/24h | sCr mg/dl | Prot g/24h | Time (months) | sCr mg/dl | Prot g/24h | Response | |||||||
| 1 | 27 | Female | V | CYC/MMF/ RTX | 0.6 | 5.70 | 0.8 | 1.60 | 0.8 | 3.00 | 12 | 0.8 | 3.00 | PR |
| 2 | 31 | Male | V | CYA/MMF | 1.0 | 1.60 | 0.9 | 0.09 | 6 | 0.9 | 0.09 | CR | ||
| 3 | 41 | Female | IV-S A/C + V 67% crescents | MMF/CYC | 1.0 | 4.40 | 1.4 | 2.70 | 8 | 1.4 | 3.30 | NR | ||
| 4 | 25 | Female | III A + V 10% crescents | CYC/MMF | 0.9 | 3.30 | 0.8 | 1.30 | 0.9 | 1.90 | 27 | 1.0 | 0.97 | PR |
| 5 | 39 | Female | IV-G A/C + V 42% crescents | MMF/CYC/ RTX | 0.6 | 4.50 | 0.7 | 1.10 | 6 | 0.8 | 1.10 | PR | ||
| 6 | 34 | Female | III A + V | MMF/CYC | 0.6 | 4.00 | 0.7 | 1.80 | 0.6 | 1.30 | 39 | 0.6 | 1.70 | PR |
| 7 | 35 | Female | III A/C + V | CYC/MMF | 1.1 | 2.40 | 1.2 | 2.5 | 1.4 | 1.20 | 24 | 1.3 | 1.70 | PR |
| 8 | 42 | Female | IV-S A/C + V 32% crescents | CYC/MMF | 1.1 | 4.00 | 0.9 | 1.2 | 1.1 | 0.05 | 38 | 0.9 | 0.23 | CR |
ISN/RPS: International Society of Nephrology / Renal Pathology Society – CYC: Cyclophosphamide – MMF: mycophenolate mofetil – RTX: Rituximab – CYA: Cyclosporine A – sCr: creatinine – Prot: proteinuria – CR: complete response – PR: partial response – NR: no response